Chapel Hill, NC (Vocus) June 23, 2009 -- Blue Cross and Blue Shield of North Carolina (BCBSNC) has found a payoff – both in health quality measures and in lower health care spending – for encouraging physicians to meet national quality standards.

Patients of physicians meeting standards for efficiencies in practice management receive fewer high-cost imaging tests such as CT scans, a data analysis by BCBSNC shows. They also don’t visit the emergency room or medical specialists as often. As a result, annual health care spending is less per patient than for the BCBSNC customer population as a whole.

The findings are from an analysis of claims conducted by BCBSNC’s Clinical Informatics unit. The analysis was completed at the conclusion of the company’s three-year pilot for health care quality under the national Bridges to Excellence program.

“We’ve believed for years that quality improvement leads to better health outcomes and lower costs, and now we have data that demonstrates it,” said Don Bradley, MD, BCBSNC senior vice president and chief medical officer. “Our investment in Bridges to Excellence over the past three years has made a difference for patients and physicians.”

Based on the success of the Bridges to Excellence pilot, BCBSNC is considering ways to expand the concept of providing rewards and recognition to doctors meeting quality standards. Since launching the pilot in 2006, BCBSNC and its partner in Bridges to Excellence incentives, the State Health Plan for Teachers and State Employees, have paid $4.2 million in incentive compensation to participating physicians.

Doctors have embraced BCBSNC’s efforts to bring Bridges to Excellence to North Carolina. The pilot program included 194 physicians, representing 41 practices, who earned rewards for meeting at least one quality standard. Counting all physicians in the BCBSNC network, regardless of whether they participated in the pilot, more than 970 had achieved at least one quality standard as of April 2009. When the company started the Bridges to Excellence pilot, fewer than 100 physicians in the state were recognized as having met the standards.

“The health care quality movement is here to stay, and it’s imperative that we keep this focus on quality as we embark on reforming the nation’s health care system,” Dr. Bradley said.

Jennifer Lail, MD, a pediatrician with Chapel Hill Pediatrics and Adolescents who participated in the Bridges to Excellence pilot, said the pilot was an important first step in supporting North Carolina physicians’ efforts to provide quality-based, patient-centered care.

“Ongoing self-assessment and quality improvement efforts are a critical part of any medical practice,” Dr. Lail said. “While caring for patients, physicians need some external structure and compensation as they review their practices’ data and processes. The financial benefits of Bridges to Excellence have been very useful in continuing our quality improvement efforts.”

BCBSNC’s data analysis of the Bridges to Excellence pilot shows the following:

Patients of the doctors in the program for better efficiencies in practice management – which includes information systems, patient education and care coordination – received high-cost radiology services (such as CT scans and MRIs) at a rate 12 percent lower than the control group of non-participating physicians.

These patients were also 34 percent less likely to visit the ER and 24 percent less likely to see a specialist.

There was no statistical difference in hospital admission rates between the two populations.

Among diabetes patients, those who were treated by a doctor meeting the Bridges to Excellence diabetes standards for care were much more likely to have a good blood pressure reading (defined as 13o over 80 or less).

Bridges to Excellence, a not-for-profit organization dedicated to improving the quality of care by recognizing and rewarding health care providers, has active programs in 17 states, sponsored by health plans, employers and physicians. Bridges to Excellence uses standards of care established by organizations such as the National Committee for Quality Assurance (NCQA). Nationally, 14,000 physicians representing 2,700 practices have met the program’s quality standards.

Under BCBSNC’s Bridges to Excellence pilot, physicians could participate in one or more of three programs: diabetes care, heart/stroke care, and physician practice management efficiencies.

About BCBSNC:
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.7 million members, including approximately 900,000 served on behalf of other Blue Plans. For 76 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at www.bcbsnc.com.

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